Analgesia for first rib resection can be challenging with short-and long-term consequences for patients such as acute distress, difficulty participating in physiotherapy and chronic pain. We report utilising an erector spinae plane block with a continuous infusion catheter as analgesia for a transaxillary first rib removal in a patient with venous thoracic outlet syndrome (Paget-Schroetter syndrome). We could find no reports of erector spinae plane block in transaxillary rib resection, and a limited number of reports using a paravertebral approach to analgesia for this procedure. In our case, an erector spinae plane block provided effective analgesia, allowing the patient to participate freely in postoperative physiotherapy; no complications of erector spinae plane block were encountered. Further research into the safety and efficacy of erector spinae plane block for first rib resection is warranted.

Background Non-toxic approaches to enhance radiotherapy outcomes are beneficial, particularly in ageing populations. We investigated the efficacy of high-fibre diets combined with irradiation in C57BL/6 mice bearing bladder cancer flank allografts. Result Psyllium plus inulin significantly decreased tumour size and delayed tumour growth following irradiation compared to 0.2% cellulose and raised intratumoural CD8+ cells. Post-irradiation, tumour control positively correlated with Lachnospiraceae family abundance. Psyllium plus resistant starch radiosensitised the tumours, positively correlating with Bacteroides genus abundance. Although local immunity was suppressed, psyllium plus resistant starch increased caecal isoferulic acid levels, associated with a favourable response. Both diets mitigated the acute radiation injury caused by 14 Gy. All high fibre diets increased caecal short-chain fatty acid levels. Similar gut microbiota profiles in cancer patients and low-fibre diet mice indicates scope for testing dietary fibre supplements in human intervention studies. Conclusion These supplements may be useful in combinations with radiotherapy in patients with pelvic malignancy.

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